上臂内侧皮瓣的解剖学研究及临床应用

发布时间：2018-11-26 11:31

【摘要】： 目的:本研究旨在通过对上臂内侧皮瓣深筋膜浅层以上的血管微巨解剖研究,为临床应用上臂内侧扩张皮瓣提供理论指导,并应用上臂内侧皮瓣带蒂转移修复面颈部缺损。方法:新鲜成人上肢标本10侧,左右各半,乳胶灌注血管。四倍放大镜下由浅入深进行解剖,观察浅筋膜层内血管的吻合情况及吻合支的数量,皮动脉穿出深筋膜的位置。并总结临床应用该皮瓣扩张后修复面颈部缺损24例。结果:(1)上臂内侧自深筋膜浅层发出的皮动脉8～9支,各皮动脉发出分支沿纵行方向相互吻合。上臂皮瓣的中间部位即内侧肌间隔间隙吻合支最为丰富,其次为臂内侧皮瓣的臂后侧部分。每侧肢体均有2～5支明显的贯串上臂全长的吻合支,多位于皮瓣的中部及后部。皮动脉穿出点集中臂内侧肌间隔区域,最远一支距肘横纹3.47±1.50cm,近端分支距腋窝横皱襞距离约1.64±1.22cm。(2)24例应用上臂内侧扩张皮瓣修复面颈部缺损的病例中,上臂扩张皮瓣面积最大20cm×15cm,最小4cm×5.5cm,其中以近端为蒂者12例,远端者15例,以远端为蒂者2例患者远端出现部分坏死,其余皮瓣全部成活随访3个月～2年,效果满意。结论:(1)上臂内侧皮瓣血供介于轴型皮瓣与任意型皮瓣之间,切取时长宽比例超过任意型皮瓣。皮瓣为双向供血,无论以近端为蒂还是远端为蒂切取皮瓣是安全的。以内侧肌间隔为轴线,沿深筋膜浅层设计顺行或逆行皮瓣血供可靠,切取皮瓣安全,如需扩大切取皮瓣,向后扩展延伸较向前扩展可靠。皮瓣制作时皮瓣蒂部尽可能置于肌间隔,蒂宽约4cm。以近端为蒂时,扩张器剥离腔隙近端不超过距腋窝横皱襞3cm,远端为蒂时,扩张器剥离腔隙远端不超过距肘横纹5cm。(2)上臂扩张皮瓣色泽、质地佳,经过扩张后,切取皮瓣面积较大,供区多可直接缝合,是面颈部瘢痕修复的良好供区。
[Abstract]:Objective: the purpose of this study was to provide theoretical guidance for the clinical application of medial upper arm expanded flap through the study of vascular microanatomy above the superficial layer of deep fascia of medial upper arm flap, and to apply pedicle transfer of medial upper arm flap to repair face and neck defect. Methods: 10 sides of fresh adult upper limbs were perfused with latex. Four times magnifying glass was dissected from the superficial to the depth to observe the anastomosis of the vessels in the superficial fascia and the number of anastomotic branches and the position of the cutaneous artery perforating the deep fascia. The clinical application of the flap to repair 24 cases of face and neck defect was summarized. Results: (1) the medial upper arm gave off 89 cutaneous arteries from the superficial layer of deep fascia, and the branches of each cutaneous artery were anastomosed with each other along the longitudinal direction. The middle part of the upper arm flap, the anastomotic branch of the medial septal space, was the most abundant, followed by the posterior arm part of the medial arm flap. In each limb, there were 2 or 5 obvious anastomotic branches of the upper arm, most of which were located in the middle and posterior part of the flap. The distance from the medial arm muscle septum to the elbow transverse stria was 3.47 卤1.50 cm, and the distance from the proximal branch to the axillary transverse fold was about 1.64 卤1.22 cm. (2) in 24 cases, the medial upper arm expanded flap was used to repair the face and neck defect, and the distance between the proximal branch and the axillary transverse fold was 1.64 卤1.22 cm. The area of the expanded upper arm flap was the largest 20cm 脳 15 cm, and the smallest 4cm 脳 5.5 cm, of which 12 cases were proximal pedicle, 15 distal and 2 distal pedicled. The remaining flaps survived for 3 months to 2 years, and the results were satisfactory. Conclusion: (1) the blood supply of medial upper arm flap is between the axial flap and the arbitrary flap. The flap is a two-way blood supply. It is safe to cut the flap with proximal or distal pedicle. With the medial septum as the axis, the blood supply of the anterograde or retrograde flap was designed along the superficial layer of deep fascia, and it was safe to cut the flap. If it is necessary to extend the flap, the posterior extension is more reliable than the forward expansion. When the flap was made, the pedicle was placed as far as possible in the muscular septum, and the pedicle width was about 4 cm. When the proximal pedicle was used as pedicle, the proximal end of the space was not more than 3 cm from the lateral fold of the armpit, and the distal end of the distally pedicle was not more than 5 cm. (2) the color and texture of the expanded upper arm flap was good, and after expansion, the distensibility of the distally distended space was not more than 5 cm from the transverse stripe of the elbow. The flap has a large area, and the donor area can be sutured directly. It is a good donor area for scar repair in the face and neck.
【学位授予单位】：中国协和医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R622;R322

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